Routes to diagnosis of heart failure: observational study using linked data in England

Bottle, Alex; Kim, Dani; Aylin, Paul; Cowie, Martin R.; Majeed, Azeem; Hayhoe, Benedict

doi:10.1136/heartjnl-2017-312183

Cited by 88 publications

(117 citation statements)

References 27 publications

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“…We have previously reported, using CPRD, that few who presented with symptoms suggestive of HF followed a pathway aligned with NICE recommendations 13. This study expands on this, measuring the time taken for patients to achieve key elements of these recommendations, and considering the effect of various patient-related factors.…”

Section: Discussionmentioning

confidence: 88%

“…Patients without recorded symptoms were included in previous analysis, reported elsewhere 13. Of the 16 597 patients with HF symptoms, 6464 (39%) had a recorded serum NP test and/or echocardiogram, and 6043 (36%) a specialist referral.…”

Section: Resultsmentioning

confidence: 99%

“…We have previously described lack of coding of HF symptoms,13 and we suspect clinicians are unlikely to record multiple symptom codes within a single consultation, making comparison of one or more symptoms less valid. Since 2006, the Quality and Outcomes Framework (QOF), a national primary care pay-for-performance scheme, has incentivised confirmation of HF by echocardiography or specialist assessment 34.…”

Section: Discussionmentioning

confidence: 99%

“…Comorbidities from the Charlson set were defined as per Khan et al 18 with some added by our team 13. Otherwise, codes were identified using the CPRD medical and product dictionaries.…”

Section: Methodsmentioning

confidence: 99%

“…We have established that few patients with recorded symptoms of HF follow a pathway to diagnosis supported by guidance in primary care 13. However, the extent to which NICE-recommended time limits for investigations and referral are adhered to is unclear.…”

Section: Introductionmentioning

confidence: 99%

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Adherence to guidelines in management of symptoms suggestive of heart failure in primary care

Hayhoe

Kim

Aylin

et al. 2018

Heart

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ObjectiveClinical guidelines on heart failure (HF) suggest timings for investigation and referral in primary care. We calculated the time for patients to achieve key elements in the recommended pathway to diagnosis of HF.MethodsIn this observational study, we used linked primary and secondary care data (Clinical Practice Research Datalink, a database of anonymised electronic records from UK general practices) between 2010 and 2013. Records were examined for presenting symptoms (breathlessness, fatigue, ankle swelling) and key elements of the National Institute for Health and Care Excellence-recommended pathway to diagnosis (serum natriuretic peptide (NP) test, echocardiography, specialist referral).Results42 403 patients were diagnosed with HF, of whom 16 597 presented in primary care with suggestive symptoms. 6464 (39%) had recorded NP or echocardiography, and 6043 (36%) specialist referral. Median time from recorded symptom(s) to investigation (NP or echocardiography) was 292 days (IQR 34–844) and to referral 236 days (IQR 42–721). Median time from symptom(s) to diagnosis was 972 days (IQR 337–1468) and to treatment with HF-relevant medication 803 days (IQR 230–1364). Factors significantly affecting timing of referral, treatment and diagnosis included patients’ sex (p=0.001), age (p<0.001), deprivation score (p=0.001), comorbidities (p<0.001) and presenting symptom type (p<0.001).ConclusionsMedian times to investigation or referral of patients presenting in primary care with symptoms suggestive of HF considerably exceeded recommendations. There is a need to support clinicians in the diagnosis of HF in primary care, with improved access to investigation and specialist assessment to support timely management.

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Section: Discussionmentioning

confidence: 88%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Comorbidities from the Charlson set were defined as per Khan et al 18 with some added by our team 13. Otherwise, codes were identified using the CPRD medical and product dictionaries.…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Adherence to guidelines in management of symptoms suggestive of heart failure in primary care

Hayhoe

Kim

Aylin

et al. 2018

Heart

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Heart failure symptoms as predictors of hospital admission, readmission and all-cause mortality

Ali

Freeman

Gray

et al. 2022

Cochrane Database of Systematic Reviews

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Clinical implications of the universal definition for the prevention and treatment of heart failure

Chandramouli

Stewart

Almahmeed

et al. 2022

Clinical Cardiology

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The diagnosis of heart failure (HF) primarily relies on signs and symptoms that are neither sensitive nor specific. This impedes timely diagnosis and delays effective therapies or interventions, despite the availability of several evidence‐based treatments for HF. Through monumental collaborative efforts from representatives of HF societies worldwide, the universal definition of HF was published in 2021, to provide the necessary standardized framework required for clinical management, clinical trials, and research. This review elaborates the key concepts of the new universal definition of HF, highlighting the key merits and potential avenues, which can be nuanced further in future iterations. We also discuss the key implications of the universal definition document from the perspectives of various stakeholders within the healthcare framework, including patients, care providers, system/payers and policymakers.

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Routes to diagnosis of heart failure: observational study using linked data in England

Abstract: Patients follow various pathways to the diagnosis of HF. However, few appear to follow a pathway supported by guidelines for investigation and referral. There are likely to be missed opportunities for earlier HF diagnosis in primary care.

Cited by 88 publications

References 27 publications

Adherence to guidelines in management of symptoms suggestive of heart failure in primary care

Adherence to guidelines in management of symptoms suggestive of heart failure in primary care

Heart failure symptoms as predictors of hospital admission, readmission and all-cause mortality

Clinical implications of the universal definition for the prevention and treatment of heart failure

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